Provider Demographics
NPI:1912243148
Name:BEACON BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:BEACON BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-356-1276
Mailing Address - Street 1:102 W BEATON DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-2652
Mailing Address - Country:US
Mailing Address - Phone:701-356-1276
Mailing Address - Fax:701-356-4940
Practice Address - Street 1:102 W BEATON DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-2652
Practice Address - Country:US
Practice Address - Phone:701-356-1276
Practice Address - Fax:701-356-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-16
Last Update Date:2012-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND372103TC2200X
ND421103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty